[misysme]

My mother in law is on medicare. She is widowed and has a small daycare at her home to try to pay the house payment and utilities. She pays someone to come in part time to help her with the daycare. She struggles, but seems to make it every month. At about this time every year she falls into the donut hole where her medical needs are not covered. I have looked into the programs that help with prescriptions and so far they all say that the patient cannot have any type of health insurance...she does, just not for the last 2 or three months of the year. Has anyone else had experience with this situation? Any suggestions would be greatly appreciated.

[carlacanel]

I'm really not sure what you mean by insurance because it seems that she has exhausted her drug allowance thru the Medicare Program for this year.

She should receive a check for $250 from Medicare since she has reached the donut-hole.

She may be able to contact the drug companies to see if they can provide some assistance or she might ask her Doctor for samples.

Some states have free drug discount cards for people without insurance.

Next year might be better, she'll pay half the cost of the drug when she falls into the hole.

[Cblue]

Ut oh...I have no idea what a donut hole is. I am on medicare and now I fear I will lose insurance. I am having surgery in January...I hope it is covered.

Can you tell me what it is?

Thank you in advance! Everyones help is greatly appreciated!

[ginnie]

The donut hole is a very unfair thing. It is when you are allowed so much money from medicare and they pay for most of your drugs. When that set abount runs out, you are on your own. Then you must pay out of pocket for all the remaining drugs you will need for the rest of the year. I have been in this situation many times in the last years. I spent thousands....now I have nothing. I did receive from one drug maker my supply for some of the time. my doctor provided samples but charged me if you can believe it. I didn't know what else to do....ginnie

[Shellback]

Originally Posted by virginia neill

The donut hole is a very unfair thing. It is when you are allowed so much money from medicare and they pay for most of your drugs. When that set abount runs out, you are on your own. Then you must pay out of pocket for all the remaining drugs you will need for the rest of the year. I have been in this situation many times in the last years. I spent thousands....now I have nothing. I did receive from one drug maker my supply for some of the time. my doctor provided samples but charged me if you can believe it. I didn't know what else to do....ginnie

Thankfully the money that you spend on drugs out of pocket while you are in the donut hole as well as your co-pays is tax deductible.

[Kitt]

Originally Posted by Cblue

Ut oh...I have no idea what a donut hole is. I am on medicare and now I fear I will lose insurance. I am having surgery in January...I hope it is covered.

Can you tell me what it is?

Thank you in advance! Everyones help is greatly appreciated!

Part D is what you carry if you are on drugs. The donut hole is there (Part D). Otherwise, you are not going to lose any Medicare coverage you have for like surgery, and the rest of your health issues, etc. It's the drug plan you carry (Part D), if you do in fact carry that plan.

http://healthinsurance.about.com/od/...ing_part_d.htm

[Janke]

I believe that the reason there is this 'donut hole' is that Part D Medicare (which is only a few years old) was orignally designed to cover basic medication and catastrophic costs. Not a perfect system but like Social Security, Medicare was not designed to nor can it afford to be enough to cover all your living expenses or medical bills.

[echoes long ago]

Originally Posted by virginia neill

my doctor provided samples but charged me if you can believe it.

this is a new low even for doctors

[Cblue]

OK...I do not have Part D...I pay for my own prescriptions.

Thank you everyone!!!!!

[lefthanded]

If my doctor tried to charge me for samples, I would report him to the Medical Association. The doctor does not pay for those samples, and even is often given "incentives" to make them available in his office. This is quite an ethical breach.

I would find a new doc and report this one.



As for Part D and the donut hole, it acts as sort of a delayed deductible, in that medicare pays for your drugs (with you having a co-pay) until you and they have spent a certain sum, around $2800, and then you must pay all costs until you have paid about $,500 out of your own pocket. After that Medicare once again pays for your drugs.

IMO the Part D donut hole is a cruel trick for most seniors who take expensive drugs for memory problems, cholesterol and heart issues. I think it is sad that seniors have to choose between rent, heat, food, and making drug companies rich.

I personally have begun to ration and change my drugs to avoid the donut hole. My most expensive drug is Pentasa, which runs about $750 a month if I take it full strength, putting me in the donut hole before summer begins. I have actually told my gastroenterologist I plan to wean myself off of it, because it is one of those they can't tell if it really helps or not! On top of that, many people with my medical issues do not take it at all and get by quite nicely. It is also one that the drug company keeps "tweaking" the formula on so that they can get the patent renewed, and keep jacking the price up . . . or I could get it in generic form, as it has been around for a long time.